When 62-year-old Joanie Simpson woke up with a serious backache and chest pain following the death of her beloved Yorkshire terrier, she assumed she was having a heart attack. Soon afterward, the Texas native was airlifted to a hospital in Houston, where a cardiologist administered a coronary angiogram, a special type of X-ray, to determine if her arteries were blocked. Simpson’s results came back clean.
But after further testing, a different diagnosis emerged. Doctors told Simpson she had takotsubo cardiomyopathy, also known as broken heart syndrome. She acknowledged that the death of her dog caused her extreme distress, which may have triggered the illness.
Simpson was released from the hospital after two days, and a year later, didn’t have any further symptoms. But how did emotional stress cause her broken heart?
Understanding stress
Stress is the body’s reaction to a challenge or demand placed on it. It’s a broad definition, and just about anything can be a stressor, including a job loss, a car accident, or the death of a loved one.
When you experience stress, the body releases a number of hormones that make your muscles tense up, your heart beat faster, and your lungs take in more oxygen. That’s good when you have to fight off or escape from danger, but operating your body in a constant red-alert state can cause serious health problems.
Acute stress is stress that disappears quickly. A crying baby can stress you out, but the stress goes away when the baby quiets down. Chronic stress, like that experienced during a long-term illness or difficult relationship, doesn’t go away so easily.
Can stress cause a heart attack?
While stress may not be able to directly cause a heart attack, chronic stress can cause anxiety, depression, hypertension, insomnia, a weakened immune system, and a host of other problems, all of which may increase your risk for heart troubles. When you’re stressed, you may also engage in unhealthy behaviors like smoking, not exercising enough, and having an unhealthy diet, all of which raise your risk for heart disease.
In addition to raising heart disease risk factors, stress can directly cause more serious health problems. One 2022 study published in the journal JAMA Network Open found a definite link between psychosocial stress and a person’s risk of having a stroke.
A separate 2020 study published in the Journal of the American Heart Association found that the risk of stroke was highest in the 30 days after a spouse’s death, and remained slightly higher in the five years after.
Stress and broken heart syndrome
Severe emotional or physical stress can also cause broken heart syndrome, a temporary condition that mimics symptoms of a heart attack. The most common symptoms is chest pain, but some people may have shortness of breath or fainting. Physical triggers are usually serious health experiences like surgery. Emotional triggers tend to be deaths, conflicts with loved ones, intense fear, rage, or anxiety. In broken heart syndrome (also known as stress cardiomyopathy or takotsubo cardiomyopathy), stress cause the left ventricle of the heart to balloon. The left ventricle is the primary chamber of the heart, and it’s in charge of pumping blood into the biggest artery in the body, the aorta. When it balloons, it isn’t able to pump enough blood, a condition called acute systolic heart failure. Broken heart syndrome may sometimes affect both right and left ventricles of the heart, too.
Broken heart syndrome is typically temporary, and about 95 percent of people recover fully. According to a 2020 review published in Journal of the American Academy of Physician Assistants, about 7 percent of people with broken heart syndrome experienced serious complications such as stroke.
When someone experiences symptoms of broken heart syndrome, both the symptoms and the results of an electrocardiogram test (EKG) will show signs that closely resemble acute myocardial infarction, or heart attack. It’s only when another test called a coronary angiography is done that the differences really come through. That test uses a special dye and X-rays to see whether there are blockages in the arteries. If there are none, then that’s evidence pointing toward broken heart syndrome.
Who is at risk?
There is still a great deal that researchers don’t know about this condition, including all the risk factors. However, evidence points to a few groups who seem to experience broken heart syndrome more than others.
Around the world, most (90 percent) of people who have experienced this condition have been women, primarily those who have already gone through menopause. However, men are more at risk of both more severe episodes and death.
According to the 2020 review published in the Journal of the American Academy of Physician Assistants, there is some evidence that broken heart syndrome could be related to mental health. People who have panic disorder and anxiety disorders may be at higher risk—well over half of patients with broken heart syndrome had a history of either a psychiatric or neurologic disorder, more than twice the frequency than in patients with acute coronary syndrome (a medical emergency that can lead to a heart attack).
Your best defenses against stress
One of the best ways to relieve stress and help your heart at the same time is exercise. Not only does it improve your physical condition, but exercise can also reduce stress hormones and release endorphins, the body’s natural painkillers and mood elevators. Experts recommend getting at least 150 minutes per week of moderate-intensity exercise like brisk walking or yoga, or 75 minutes per week of vigorous-intensity exercise like swimming or running.
The American Psychological Association has two additional recommendations—a social network and rest. Building and nurturing a support network of friends and family can go a long way toward helping you manage and weather life’s inevitable stressors. Adequate sleep, too, is a necessary ingredient for stress management. Aim for about 7-8 hours of sleep each night, and try to make a habit of a regular bedtime.
And if you need help, ask your healthcare provider for guidance on reducing your stress.
Call 911 or go to your nearest emergency room for the following symptoms. Emergency medical workers can do tests to figure out whether you are having a heart attack or some other issue is causing your symptoms:
- Chest pain or pressure
- Problems breathing
- Sudden dizziness
- Pain or discomfort in the shoulder, arm, back, neck, jaw, teeth, or upper belly
- Nausea or vomiting
- Cold sweat
- Sudden fatigue
Sources: Mayo Clinic. Heart attack. Page last upd... + 12
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- American Psychological Association. Stress effects on the body. Page last updated March 8, 2023.
- American Psychological Association. Stress won’t go away? Maybe you are suffering from chronic stress. Page last updated November 1, 2022.
- American Heart Association. Stress and Heart Health. Page last reviewed June 21, 2021.
- Reddin C, Murphy R, Hankey GJ, et al. Association of Psychosocial Stress With Risk of Acute Stroke. JAMA Netw Open. 2022 Dec 1;5(12):e2244836.
- Fenger-Grøn M, Paulsen Møller I, Schou Pedersen H, et al. Death of a Partner and Risks of Ischemic Stroke and Intracerebral Hemorrhage: A Nationwide Danish Matched Cohort Study. J Am Heart Assoc. 2020 Dec;9(23):e018763.
- Johns Hopkins Medicine. Broken Heart Syndrome. Page accessed December 13, 2023.
- Johns Hopkins Medicine. Systolic Heart Failure. Page accessed December 13, 2023.
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- Centers for Disease Control and Prevention. Adult Activity: An Overview. Page last updated December 20, 2023.
